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In a crossover trial, a gown designed to increase skin coverage at the hands and wrists significantly reduced contamination of personnel during personal protective equipment (PPE) removal, and education on donning and doffing technique further reduced contamination. Simple modifications of PPE and education can reduce contamination during PPE removal.

Observational cohort study of MRSA-colonized patients to determine the frequency of and risk factors for environmental shedding of MRSA during procedures and care activities in carriers with positive nares and/or wound cultures. Bivariate analyses were performed to identify factors associated with environmental shedding.

Setting:

A Veterans Affairs hospital.

Participants:

This study included 75 patients in contact precautions for MRSA colonization or infection.

Results:

Of 75 patients in contact precautions for MRSA, 55 (73%) had MRSA in nares and/or wounds and 25 (33%) had positive skin cultures. For the 52 patients with MRSA in nares and/or wounds and at least 1 observed procedure, environmental shedding of MRSA occurred more frequently during procedures and care activities than in the absence of a procedure (59 of 138, 43% vs 8 of 83, 10%; P < .001). During procedures, increased shedding occurred ≤0.9 m versus >0.9 m from the patient (52 of 138, 38% vs 25 of 138, 18%; P = .0004). Contamination occurred frequently on surfaces touched by personnel (12 of 38, 32%) and on portable equipment used for procedures (25 of 101, 25%). By bivariate analysis, the presence of a wound with MRSA was associated with shedding (17 of 29, 59% versus 6 of 23, 26%; P = .04).

Conclusions:

Environmental shedding of MRSA occurs frequently during medical procedures and patient care activities. There is a need for effective strategies to disinfect surfaces and equipment after procedures.

A DNA marker inoculated onto portable equipment on a medical ward was disseminated to other wards when equipment was shared and to a physician work room and the hospital cafeteria by personnel. These results demonstrate the plausibility of pathogen transmission in healthcare facilities in the absence of shared ward exposure.

A DNA marker inoculated onto shared portable equipment in surgical and medical intensive care units disseminated widely to surfaces in patient rooms and provider work areas and to other types of portable equipment. These results demonstrate the potential for contaminated portable equipment to serve as a vector for dissemination of pathogens.

An ethanol-based spray disinfectant significantly reduced bacteriophage MS2 contamination on material from gowns meeting ASTM standard 1671 for resistance to blood and viral penetration and on a cover gown worn by personnel. Effectiveness of disinfection was affected by the type of gown material and the correctness of fit.

Hospital floors are frequently contaminated with pathogens, but it is not known whether floors are a potential source of transmission. We demonstrated that a nonpathogenic virus inoculated onto floors in hospital rooms disseminated rapidly to the hands of patients and to high-touch surfaces inside and outside the room.

In an experimental study, the frequency of contamination of healthcare personnel during removal of contaminated personal protective equipment (PPE) was similar for bacteriophage MS2 and a novel reflective marker visualized using flash photography. The reflective marker could be a useful tool to visualize and document personnel contamination during PPE removal.

Infect Control Hosp Epidemiol 2016;37:711–713

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